Results of the national registry of patients diagnosed with inflammatory bowel disease candidates for bariatric surgery (ReNacEIBar).

BACKGROUND: Our aim is to carry out a national registry of patients with inflammatory bowel disease (IBD) who underwent bariatric surgery, as well as evaluate the results and management of this type of patients in the usual clinical practice. METHODS: National multicentric observational retrospective study, including patients, previously diagnosed with IBD who underwent bariatric surgery from January 2000 to December 2022. RESULTS: Forty-one patients have been included: 43,9% previously diagnosed with ulcerative colitis, 57,3% Crohn's disease, and an indeterminate colitis (2,4%). The preoperative BMI was 45.8 ± 6,1 kg/m2. Among the bariatric surgeries, 31 (75,6%) sleeve gastrectomy, 1 (2,4%) gastric bypass and 9 (22%) one anastomosis gastric have been carried out. During the postoperative period, 9.8% complications have been recorded. BMI was 29,5 ± 4,7 kg/m2 and percent total weight lost was 33,9 ± 9,1% at 12 months. CONCLUSIONS: Bariatric surgery in patients with inflammatory bowel disease can be considered safe and effective.

Posterior retroperitoneoscopic adrenalectomy: recommendations to implement this approach. / Suprarrenalectomía retroperitoneoscópica por vía posterior. Recomendaciones para la implementación de esta técnica.

INTRODUCTION: The posterior retroperitoneoscopic approach (PRA) is seldom used in our country to perform adrenalectomies, although it offers possible advantages over laparoscopic anterior or lateral access, according to some authors. The aim of this study was to identify those features that determine the most suitable cases to start the implementation of this technique. METHODS: A prospective observational study was performed with a 50 patients cohort. All the cases were operated using the PRA. Sex, age, body mass index (BMI), operative time, left or right side, size and anatomopathological characteristics of the lesion, conversion rates, complications and hospital stay were analyzed. RESULTS: 25 (50%) women and 25 (50%) men underwent surgery, with a median operative time of 80 minutes (45-180). A significantly shorter operative time (p = 0.002) was observed in women and in adenomas (p = 0.002). However, no correlation was observed between surgical time and BMI, lesion side or lesion size. There were no conversions. The complication rate was 14%, and most of the complications were grade i in Clavien Dindo's Scale. Median hospital stay was two days. CONCLUSIONS: Retroperitoneoscopic adrenalectomy by posterior approach is a safe and reproducible procedure, with very good outcomes. The most suitable cases to implement this technique would be female patients with adrenal adenomas.

Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case Report.

BACKGROUND: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-s) is a well-known and accepted technique for extreme obesity but technically challenging in this group of patients and so frequently is performed as a laparoscopic staged procedure. Robotic devices such as Da Vinci® system may solve some limitations of laparoscopic surgery. The video shows a really totally robotic SADI-s (RTR-SADI-s) in a single stage on a patient with extreme morbid obesity and a non-reducible umbilical hernia. METHODS: A 56-year-old female patient with BMI = 58 kg/m2 and a large non-reducible umbilical hernia was planned for a RTR-SADI-s. A Da Vinci Xi® model was used and neither laparoscopic assistance nor change of surgical table position was needed. RESULTS: The patient was in 20° reverse Trendelenburg position during all the procedure, with open legs and arms in complete adduction. All trocars were robotic. After the umbilical hernia reduction, a 300-cm ileal loop was measured and temporarily attached to the right hypochondrium peritoneum. The gastric sleeve was performed 6 cm from the pylorus over a 36Fr bougie. A robotic hand-sewn four-layer duodenoileal anastomosis was performed with barbed absorbable sutures. Docking time was 8 min. Total operative time was 240 min, of which 165 min corresponded to the SADI-s procedure and 75 min to the reduction and reparation of the umbilical hernia. There were no complications during or after surgery, and the patient was discharged on the third postoperative day. CONCLUSIONS: Robotic platforms can significantly minimize the difficulty of bariatric surgery, allowing one-stage procedures in patients with extreme obesity that could require two-stage procedures in a laparoscopic approach.

Clinical Feasibility of Large Gastrotomy Closure Using a Flexible Tissue Glue Based on N-Butyl-2-Cyanoacrylate: Experimental Study in Pigs.

BACKGROUND: The use of synthetic adhesives such as cyanoacrylates has been established previously for a wide range of clinical indications. However, more research is necessary to evaluate their use in digestive closures or anastomosis. New chemical formulations developed to achieve more flexibility of synthetic adhesives (i.e., based on n-butyl-2-cyanoacrylate) could be an alternative to achieve this purpose. The aim of this study was to investigate the feasibility of using flexible cyanoacrylate adhesives for large gastric incision closure in an animal model. METHODS: Twelve farm pigs were divided in two groups depending on the type of closure method applied. In all cases, extra-large seven centimeters gastrostomies were performed. Braided absorbable hand-sewn interrupted suture versus n-butyl-2-cyanoacrylate with softener closure were compared during a 3-week follow-up period. Histopathological aspects, hematologic and inflammatory biomarkers, and endoluminal pressure tolerated until leakage were assessed. The time spent on both closing procedures was compared. RESULTS: No differences between the two groups were found in any of the histopathological and inflammatory variables evaluated. The glued group tolerated a significantly higher pressure than the manual suture group. A reduction of surgery time was also observed. CONCLUSIONS: Our results suggest that flexible cyanoacrylates could be a feasible alternative to improve the clinical outcome of the closure of hollow viscera through more efficient sutureless procedures.

Introduction of Flexible Cyanoacrylates in Sutureless Gastric Closure.

Background Clinical effectiveness and safety of biological and synthetic adhesives in digestive closures have been evaluated. Their use is becoming more prevalent, as rigidity and inflexibility are its more remarkable weaknesses. However, little is known about their role in gastric and anastomotic closures. Moreover, usefulness of novel flexible types of synthetic adhesives as n-butyl-cyanoacrylate has not been assessed yet. Materials and Methods One centimeter long gastrotomy was performed in 24 male Wistar rats, which were divided depending on the type of closure method employed: manual USP 5/0 silk interrupted suture versus sutureless closure with Histoacryl Flexible (n-butyl-cyanoacrylate with softener) or Histoacryl Double Component (n-butyl-cyanoacrylate with softener and hardener). Microscopic evaluation of the suture viability and integrity was performed, and adhesion formation during the cicatrization process were assessed. During an 8-week follow-up clinical and histopathological aspects as well as hematologic and inflammatory biomarkers were studied. Results No differences among groups where found in any of the clinical, analytical, or histopathological issues assessed except for a higher incidence rate of adhesions in the Histoacryl Double Component group when compared with hand-sewn suture group (P = .04). Our results support experimental studies in large mammals (pigs) for further study of sutureless hollow viscera closure.